A Critical Evaluation of Hepatic Resection in Cirrhosis: Optimizing Patient Selection and Outcomes

Abstract

Hepatic resection has long been the mainstay of treatment of primary liver cancers, particularly hepatocellular carcinoma (HCC). Because of the high incidence of cirrhosis in patients with HCC, the use of resection was initially limited by the ability of the cirrhotic liver to sustain the surgical insult and the mass reduction. Today, hepatectomy in cirrhosis is undergoing a remarkable evolution. Although surgical and anesthetic improvements have increased the safety of this option, the rapid development of alternative therapies has decreased the need for it. Local excision for small HCC is likely to be replaced by image-guided, percutaneous ablative techniques. Furthermore, total replacement of a cirrhotic liver may be a more effective long-term cure than resection. Unquestionably, resection remains the optimal approach for patients with large tumors and healthy underlying liver function. The role of rapidly evolving new approaches will remain the subject of intensive inquiry in the years to come. In this report, we have attempted to clarify current practice with respect to the evaluation, selection, and technique of resection in cirrhosis, and identify areas of active inquiry.

Effects of interferon alpha treatment on recurrence and survival after complete resection or ablation of hepatocellular carcinoma: A meta‐analysis of randomized controlled trials

“…12 Considering the conflicting or inconclusive data, to reach a general conclusion, we conducted this meta-analysis with the first objective to evaluate the effect of IFN-a on overall early recurrence and survival after resection or ablation, and second to evaluate the impact of IFN-a on early recurrence and survival after liver resection that is the mainstay of treatment for primary liver cancers. 36 …”

Diagnosis and Management of Hepatocellular Carcinoma: Results of a Consensus Meeting of The Ottawa Hospital Cancer Centre

“…Accordingly, estimates suggest that only 15%-30% of patients with hcc are candidates for resection at the time of presentation 23 . As a result of advances in patient selection and surgical resection procedures, particularly in cirrhotic patients, the perioperative mortality in hcc is below 3%, and 5-year survival rates are at least 50% 24,25 .…”

Hepatocellular carcinoma: Defining the place of surgery in an era of organ shortage

“…Consequently, only 15%-30% of patients with HCC are candidates for LR at the time of presentation [4] . Although the advantages of LR over LT are not clear-cut, patients with well-preserved liver function (Child-Pugh A) with small solitary (< 5 cm) HCCs should be considered forare those with Child-Pugh B cirrhosis or those with large (> 5 cm) or multiple tumours.…”